Deb Lemons, Spine Surgery:

For six long years, Deb Lemons coped with excruciating lower back pain. Still, the 48-year-old Texas Township resident remained busy as a mother, wife and self-employed businesswoman.

“I functioned as best I could without the pain interfering with my life,” said the California native who owns Falcon Business Enterprises. “I worked at a marketing communications firm for many years and then started my own business over the past three years. I tried to focus on my life, not the pain, although it’s a very disabling pain.”

Lemons visited a number of physicians after the pain started in 2002, all without a clear identification of the cause. “I went to physical therapy for four or five years and tried many remedies to solve the problem,” she said, all to no avail. “If you can rate pain from zero to 10, with 10 being the worst, I was chronically at eight or nine,” Lemons said. “I refused to take drugs for pain in fear of becoming addicted and I wouldn’t let it over-ride me.”

A crucial clue and step in locating the source of the pain came when doctors found that injecting cortisone directly into the SI joint in her back would relieve the pain for a few hours. With out this injection, the cause of SI joint dysfunction is rare to diagnose. The SI, or sacroiliac joint, is the joint between the sacrum, at the base of the spine, and the portion of the pelvis called the ilium. The two are joined by strong ligaments and are like shock absorbers, providing stability to the body.

Injury of the joint is just one of the causes of this often debilitating pain, which can spread from the lower back into the upper back muscles, sciatica nerves and into the legs.

For Lemons, the pain came with an injury that caused the SI joint bones rub against each other, triggering muscle degeneration, a breakdown of the bones themselves and severe inflammation. Lemons said that the cause of her pain remained hidden for so long because problems in the SI joint are not detectable on any tests, including x-rays, magnetic resonance imaging (MRI) or computed tomography (CT) scans.

Once the source of the problem was identified, Lemons launched a search for a physician who could relieve the pain. “I went to many specialists who always recommended that I not have the surgery because SI joint surgery had not been successful to date,” she said.

It was recommended that she go to Bruce Dall, MD, an orthopedic spine surgeon at Neurosurgery of Kalamazoo at Borgess, who is one of the few surgeons in the region who not only does this surgery, but has developed new innovative procedures that have been proven effective.

“Dr. Dall walked me through the surgery,” Lemons said. “He explained the procedure in a clear and factual way. The SI joint fusion he would perform was less invasive and the percentage of pain reduction was very high.” In this delicate surgery, Dall fuses the SI joint, preventing the bones from rubbing against each other and reducing the severity of pain significantly. Lemons underwent the surgery on October 12, 2006, at Borgess Medical Center.

Dall said that the significant reduction in pain in Lemon’s case reflects a growing awareness in the medical community about the contribution of SI joint problems and lower back and associated pain. Dall, who has been a leader in perfecting SI Joint Fusion surgery in this country, said that fusions were done as early as the 1930s. The practice fell out of favor as surgeons favored lumbar spine surgery in effort to relieve lower back pain.

Part of the evolution of approaches in the search for the most effective treatment is based on the fact that there isn’t always a direct correlation between a person’s pain and change that can or cannot be seen on x-ray or MRI images. Dall said he did his first SI joint surgery in 1991 and has done about 150 procedures since. The Journal of Spinal Disorders published a paper written by Dr. Dall in 2001, which has prompted other surgeons to take a closer look at the SI joint surgery to treat lower back pain in qualified patients. “The surgery described in the 2001 paper has held up to the test of time,” Dall said. In Lemons’ case, Dall widened the gap in the SI joint and inserted a small “cage” that contained bone-growth-spurring material that keeps the two bones from rubbing together. He also employed screws and a rod to hold the SI joint immobile.

“Deb has rehabilitated very well,” Dall said. “She’s not perfect, but the pain is significantly diminished.”

When it comes to pain relief, SI joint fusion is typically used as a last resort. Dr. Dall said that the SI joint is one of several possible sources of low back pain and that other causes, such as disc herniation or degenerative disc disease should be ruled out first. He added that the key to diagnosing SI joint pain is the injection of pain-killing novocain into the joint. If pain lessens for two to four hours – the duration of the medicine’s beneficial impact – then the patient is a candidate for SI joint treatment, including surgery when necessary.

Dall continues to refine fusion surgery in an effort to be less invasive and to accomplish the pain-relief goal as simply as possible. In some cases, he said he only inserts the “cage” to separate the SI joint and does not use screws and a rod. While surgery is the last resort, it can have an immediate impact.

“The instant I woke up [after surgery], I could tell the pain was virtually gone,” Lemons said. She remained at Borgess for about five days and was in a TLSO body brace for three months to allow the body to heal. “Three months may seem like a long time in a brace, but compared to six years with chronic pain, it was nothing,” she said.

Today, Lemons has limited movement in her left hip, but moves so freely that any restrictions are not apparent. “I now have very little pain,” she said. “I’d rate the pain at a three or four on that scale of zero to 10.” Long active in various sports, she has been able to play a little racquetball and swim and hopes to begin fencing again soon, a sport she loves. She is also looking forward to biking and hiking.

“The muscles and nerves are still healing, but overall, I’m in really good shape,” she said. “I’m very blessed. I have my health and I am able to function with very little pain. Dr. Dall is an exceptional and skilled doctor.”

Lemons has met and spoken to other people with SI joint pain and, as someone who has endured the pain and found relief, she gladly offers help and support to anyone she can. “I want to share what I’ve learned,” she said. “Dr. Dall refers people to me to help understand what the surgery and recovery is like as a patient and I try to support anyone going through it.”

Looking back, she said it was very hard to deal with the pain all the time and still be a functioning and happy person. She praised the support of her husband, Mark, who works at Pfizer, sons Kyle, 19 and Drew, 14, who used good humor in the mist of such a difficult challenge.

“I’m also lucky that there is a doctor near-by who could do this unique surgery, which is clearly cutting-edge, innovative medicine,” stated Lemons.